“Consent”, “informed consent” or “real consent”  - Whether or not ‘informed consent’ as understood in the legal and medical parlance, was obtained from the Complainant before subjecting her to colonoscopy procedure? - Fundamentally, the law requires the disclosure to the patient, information relating to the diagnosis of disease: nature of the proposed treatment: potential risks of the proposed treatment and the consequences of the patient refusing the suggested line of treatment. Disclosure/explanation of such information to the patient by the Treating doctor and the patient’s conscious decision, in this behalf, before venturing into the suggested procedure/treatment, is the basic attribute of an informed consent, which is considered mandatory in every field of surgical procedure/intervention - The only exception to this general rule is the emergency medical circumstances, where either the patient is not in a medical condition or mental state to take a conscious decision in this regard. 

Held,     the doctrine of Consent, stems from the notion that every adult human body, with a sound mind, has a right of self-determination and personal autonomy to decide what shall be done with his own body, a fundamental aspect of the right to health - the basic principle, which permeates through all cases. Consent is not a mere acceptance of a medical intervention, but a voluntary informed decision by the patient, whether or not to opt for a particular medical procedure. It may be conceded that while Consent by the Patient for simple procedures may sometimes be implied but it needs little emphasis that invasive treatments do require explicit Consent.

 

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Invasive procedure - Informed consent  - Being a medical invasive procedure, performed on a live body, we have no hesitation in reaching the conclusion that a valid/informed consent was required to be obtained from the Complainant before subjecting her to colonoscopy procedure - Gravamen of the controversy between the parties is whether consent was at all taken and if taken, whether it was a valid consent?  - consents are got signed in the OPD room, where Colonoscopy procedures are conducted, “by the staff” - leaves little scope for doubt in our mind that the consent forms were got signed by the staff before the procedure was conducted by the Doctors, as a formality and does not meet even the basic mandatory requirements of the Treating doctor, making the Complainant aware of material risks involved in the Colonoscopy procedure, before she was subjected to the same - There is not even a whisper that the Treating doctor had explained to the Complainant the pros and cons: the material risks involved and the benefits of the procedure, particularly keeping in view her age and health condition, now being highlighted - Onus was on the Respondents, in particular the Treating doctor, to prove that it was infact taken, which, evidently, they have failed to discharge.  

 

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Consumer Protection Act, 1986, 13(2)  -  Filing of written statement after 45 days - Written version has to be filed before the concerned Fora, within the extended period of 45 days-   The matter has been considered by the Hon’ble Supreme Court on a number of occasions already.  In an order passed on 04.02.2015 in Civil Appeal No. 10941 – 10942 / 2013 “New India Assurance Co. Ltd. Vs. Hilli Multipurpose Cold-storage Private Limited” [as reported in 15(6) RAG 551]” it was ordered that the written version, which was filed beyond the permissible period, shall not be allowed to be taken on record.  However, as per order passed by the Hon’ble Supreme Court on 11.02.2016 in Civil Appeal No. 1083-1084/2016, Bhasin Infotech and Infrastructure Pvt. Ltd. vs. Grand Venezia Buyers Association, and allied matters”, the matter stands referred to a larger Bench of the Hon’ble Supreme Court, and it is still under their consideration.  In the meantime, however, the Hon’ble Supreme Court passed an order “Reliance General Insurance Co. Ltd. & Anr. vs. M/s Mampee Timbers & Hardwares Pvt. ltd. & Anr. [Civil Appeal D. No. 2365 of 2017 decided 10.02.2017]”, in which, it has been stated as follows:

“We consider it appropriate to direct that pending decision of the larger bench, it will be open to the concerned Fora to accept the written statement filed beyond the stipulated time of 45 days in an appropriate case, on suitable terms, including the payment of costs, and to proceed with the matter.” https://www.facebook.com/groups/punjablawreporter/permalink/2168213113206988/


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Consumer Protection Act, 1986 (68 of 1986) - Against the orders of StateConsumer Disputes Redressal Commission, instant writ petition is not maintainable - Constitution of India, Art. 226. (181) PLR

Consumer Protection Act, 1986 (68 of 1986) - National Commission in exercise of revisional jurisdiction was only concerned about the correctness or otherwise of the order of the State Commission setting aside the relief given by the District Forum and to pass such order as the State Commission ought to have passed - However, the National Commission has gone much beyond its jurisdiction in awarding the relief which was neither sought in the complaint nor before the State Commission.  (S.C.)(179) PLR

Consumer Protection Act, 1986 (68 of 1986) - Second complaint to the District Forum is maintainable when the first complaint was dismissed for default or non-prosecution  Civil Procedure Code 1908 (V of 1908) Order 9 Rule 9(1). (181) PLR (S.C.)

Consumer Protection Act, 1986 (68 of 1986) S. 19 - It is open to the National Commission to pass an appropriate interim order including conditional order of stay - Entertainment of an appeal and stay of proceeding pursuant to order impugned in the appeal stands at different footings, at two different stages - One (pre-deposit) has no nexus with merit of the appeal and the other (grant of stay) depends on prima facie case; balance of convenience and irreparable loss of party seeking such stay. (S.C.)(175) PLR

Consumer Protection Act, 1986 (68 of 1986) S.  2(1)(a) - Punitive damages - Neither there is any averment in the complaint about the suffering of punitive damages by the other consumers nor the appellant was aware that any such claim is to be met by it - Normally, punitive damages are awarded against a conscious wrong doing unrelated to the actual loss suffered - Such a claim has to be specially pleaded.  (S.C.)(179) PLR

Consumer Protection Act, 1986 (68 of 1986) S.  2(1)(v) - Unfair trade practice - Chevrolet Car - Purchased for Rs.14 lakh paid Rs.1,91,295/- and get fixed accessories - He had used it for a period of about one year and it has run approximately 14,000 kms, we consider it appropriate that the respondent should refund a sum of Rs.12,50,000/- (Rupees twelve lacs fifty thousand only) to the petitioner subject to the condition that the vehicle in question, without the accessories, which the petitioner got fixed at a cost of Rs.1,91,295/-, is returned to the respondent - Order upheld.  (S.C.)(179) PLR

Consumer Protection Act, 1986 (68 of 1986) S.  2(1)(v) - Unfair Trade Practice - There can be hardly any doubt that the motor vehicle Chevrolet forester AWD model was not a vehicle of the said description in as much as it was not a SUV vehicle - Therefore, the petitioner must have been misled on that score to believe that the vehicle offered for sale was a SUV - This act of the respondent would clearly fall within the mischief of unfair trade practice as envisaged in section 2(r).  (S.C.)(179) PLR

Consumer Protection Act, 1986 (68 of 1986) S.  3 - Is in  addition to and not in derogation of any other law for the time being in force - It clearly indicates that the remedy under the CP Act is an additional remedy - Furthermore, the provisions of the Code of Civil Procedure are applied only to limited extent - The provisions of Code of Civil Procedure have not been made strictly applicable to the proceedings under the CP Act - The proceedings under the CP Act by no stretch of imagination or of reasons can be equated with the civil suit. (174) PLR

Consumer Protection Act, 1986  - Second complaint to the District Forum is maintainable when the first complaint was dismissed for default or non-prosecution. (2016)3 PLRSC 200

Consumer Protection Act, 1988 (59 of 1988) - If there is any error in the judgment of theConsumer Forum, the proper remedy will be only to approach the higher forum of adjudicatory tier and cannot be brought by means of a challenge through the civil suit - The civil suit is incompetent to be entertained and with no specific averment of how and why the judgment of the District Forum could not be set aside in appeal - The order passed by the Forum have been admitted the plaintiff's case to be true. (181) PLR 

Critical Illness  - When the contents of the discharge summaries are seen against the requirements of what constitutes a CRITICAL ILLNESS under the policy, it becomes quite clear that the petitioner complainant’s case cannot be called a case of critical illness - This does not mean that his illness or treatment was not real or not important - It only means that his claim under critical illness category cannot be sustained.   NCDRC ON LIFE INSURANCE 2017 ...172

Critical illness policy - Angioplasty -  Critical benefit clause in the insurance policy, came to the conclusion that Angioplasty was not covered as an additional benefit under the critical illness benefit -  On reading of clause (B) of the note defining critical illness, so far as heart ailment is concerned, critical illness benefit has been extended under the policy for critical coronary heart by-pass graft surgery and the clause specifically provides that balloon angioplasty, laser or any catheter based procedures are not covered under the critical illness benefit.   NCDRC ON LIFE INSURANCE 2017 ...67

Diabetes Mellitus  - Contention  that even if the insured was suffering from Diabetes Mellitus, it had no nexus with the heart problem which was cause of the death -  We do not find merit in this contention - As per medical science, Diabetes is a killer disease and if not properly controlled and cured it can result in hyper tension as also lead to heart problem or failure of other organs.   NCDRC ON LIFE INSURANCE 2017 ...163

Evidence  - CPC and Evidence Act - Insured had obtained insurance policy by concealment of his previous ailment i.e. diabetes mellitus and Palloor on the basis of the information contained in the application submitted by wife of the deceased insured to the Deputy Commissioner Fatehabad and the attested copy of the record of the treatment of the deceased at General Hospital Fatehabad duly attested by the doctor - Contention that State Commission has committed a grave error on relying upon the information contained in the aforesaid documents ignoring the fact that copies placed on record were not properly proved - As per the scheme of theConsumer Protection Act, theConsumer disputes are to be decided summarily -  Therefore, technical rules of CPC and Evidence Act are not applicable to theConsumer cases provided the principles of natural  justice are followed -  Otherwise also, original of Ex. R-4 was submitted by wife of the deceased to the Deputy Commissioner Fatehabad.    NCDRC ON LIFE INSURANCE 2017 ...163

Evidence  - Lab reports – Letter of doctor that no treatment given by him  - Survey report - Lab report placed on file that it was done on the reference of Dr K, the same doctor who had first issued the certificate on 18.06.2010 that LA was under his treatment -  In the affidavit filed on behalf of the OP nos. 1 and 2 they have submitted that the complaint was repudiated and the intimation sent to the complainant on 12.07.2010 -  The petitioner/ complainant kept silent till 2011 and thereafter issued a legal notice. The petitioner thus kept silent for 11 months after repudiation and got issued the notice obtained the second letter from the doctor after a lapse of more than 1½ years after the death of the deceased stating that he had not treated the deceased -  The petitioner even in her notice dated 19.05.2011 was silent in regard to the certificate issued by the Doctor to the opposite party and filed the complaint only after obtaining the letter from the Doctor - In his cross examination the Doctor has admitted that he had kept no records of the treatment given at his clinic -  He could not produce the OPD Register, hence, it is not clear on what basis he had issued the certificate on 07.06.2011 that life assured had not taken treatment at his Nursing Home - While admittedly the certificate dated 18.06.2010 certifying that Life Assured had taken treatment in his OPD was based on the lab report dated 04.05.2009 which was conducted on his reference.   NCDRC ON LIFE INSURANCE 2017 ...105

Evidence  - Lab reports – The report of the urine test of the deceased clearly shows that he had tested positive for sugar and albumin which would indicate that he was suffering from diabetes, and kidney failure - His Serum level was also high - The State Commission had correctly concluded that if the Doctor’s evidence is not considered, the petitioner/ complainant had failed to rebut the laboratory report which clinches the fact that the insured was diabetic as the urine sugar and albumin had been shown abnormal values.   NCDRC ON LIFE INSURANCE 2017 ...105

Evidence -  Summary proceedings -  Dr. or the witness from the Hospital  not produced – Recording of previous history in prescription slip and the discharge summary -   Contention  that State Commission has committed a grave error in relying upon the prescription slip of Dr. Prahlad Garg and Discharge Summary of City Hospital as those documents  have not been proved by the primary evidence i.e. by examining Dr. Prahlad Garg or the witness from the City Hospital -   We do not find merit in this contention for the reason that proceedings before theConsumer fora are summary proceedings in which strict technical rules of procedure and evidence are not applicable - Otherwise also, the petitioner has not shown anything on the record that he in his evidence denied correctness of prescription slip and the discharge summary -  It is also argued by learned counsel for the petitioner that recording of previous history of Diabetes Mellitus does not mean that aforesaid opinion was given by the petitioner or that he was aware of his ailment -  We do not find merit in this contention -  Both doctor Prahlad Garg and the concerned doctor of City Hospital have recorded about the previous history of Diabetes Mellitus of the patient -  This history obviously must have been given by the petitioner himself or his friend / relative, who took him to the doctor concerned or the hospital -  Therefore, there is no reason to suspect that concerned doctors of their own have recorded the previous  history – Claim rightly repudiated.   NCDRC ON LIFE INSURANCE 2017 ...142

Evidence – Photo copies  -  Evidence in appeal - Plea the insured was an alcoholic and was diagnosed with alcohol lever disease and its complications, based upon certain photocopies of the record purporting to be a Government Medical College & Hospital, Chandigarh in respect of the deceased -   It is an admitted position that no doctor who may have treated or examined the insured in Government Medical College & Hospital, Chandigarh was produced before the District Forum to prove that the deceased was an alcoholic and was diagnosed with alcohol lever disease and its complications -  Admittedly, no official from the aforesaid hospital was produced to prove that the photocopies filed by the insurer were supplied by the said hospital and were true and correct copies of the record of treatment of the deceased insured -   In fact, as noticed by the State Commission, the photocopies produced by the petitioner company were not even authenticated or certified by any official of the hospital - Even the affidavit of the person who allegedly collected these photocopies from the hospital was not filed -   Since the complainant had denied the alleged alcoholism and ailment of the insured, it was obligatory for the insurer to either produce the doctor who had allegedly treated him in the hospital or to file his affidavit -  Alternatively, it could have examined an official of the hospital to prove the authenticity of the photocopies which the petitioner company filed before the District Forum in support of its case -  In the absence of any such evidence, mere production of some unattested, unverified and unauthenticated photocopies, could not have been the basis of holding that the deceased was an alcoholic and was diagnosed with alcohol liver disease and its complications -  No application for producing additional evidence was filed by the petitioner before the State Commission, despite losing before the District Forum -  No such application is filed with this Revision Petition -   The concurrent findings of the fora below therefore, do not call for any interference by this Commission in exercise of its revisional jurisdiction.    NCDRC ON LIFE INSURANCE 2017 ...178

Fraud  - Person other than the insured himself impersonated the insured before the doctor at the time of the medical examination - Pursuant to the order of this Commission dated 17.10.2014, the petitioner corporation examined a handwriting expert before the District Forum to prove that the signatures on the proposal dated 5.6.2003 differed from the signatures on the medical report dated 10.6.2003, meaning thereby that the proposer himself had not appeared before the doctor who medically examined him vide report dated 10.6.2003 -  In the absence of any handwriting expert from the complainant, the expert opinion produced by the petitioner corporation needs to be accepted and,  therefore, it stands established that a person other than the insured himself impersonated the insured before the doctor at the time of the medical examination - The aforesaid impersonation obviously could not have been possible without the insured himself being a party to it - The insurance policy, therefore, was obtained by playing a fraud  - The purpose of such impersonation obviously would be to rule out the possibility of  the doctor detecting the illness/disease from which the insured might be suffering, during the course of the medical check-up - The insurance policy having been obtained by playing a fraud upon the insurer, the contract of insurance was voidable at the option of the insurer.   NCDRC ON LIFE INSURANCE 2017 ...126

Fraud – Duty of state commission  - Insured B  - It has been stated that the insured had taken treatment in Ghaziabad impersonating himself as R and enjoyed the benefits under the Central Government Health Scheme (CGHS) in the name of R -   The information obtained under the Right to Information Act reveals that R was a constable in Delhi Police and was suffering from neck problem only -   The State Commission should have examined the relevant medical record available at the places, where the treatment was taken in order to find out whether it was B, who had taken the treatment or it was R -   It is, therefore, necessary that the matter be thrashed out in detail to bring out, whether there has been an act of fraud on the part of the insured.  It is evident from the facts recorded above that the order of the State Commission has not taken into account the crucial issue involved in the matter and decided the case, based on technical aspects only.  The order passed by the State Commission is, therefore, perverse in the eyes of law and the same is hereby set aside.   NCDRC ON LIFE INSURANCE 2017 ...73

Free Look Period  -  Request for cancellation and refund of the premium paid was sent after the free look period, as such the policy could not be cancelled as per the IRDA regulations and also as per the terms of the policy contract.   NCDRC ON LIFE INSURANCE 2017 ...120

Insurance Act, Section 45  - Material fact - Suffering from diabetes, hypertension etc. and getting treatment for ARF was a material fact which must be within the knowledge of the deceased policy holder -  It was, therefore, the bound duty of the deceased to have disclosed these facts and for his failure to do so, he cannot take advantage of section 45 of Insurance Act, on the ground that the death took place after two years of obtaining the policy in question -  Even after the lapse of two years of taking the policy, it was necessary to disclose information about the material facts before the Insurance Company.    NCDRC ON LIFE INSURANCE 2017 ...95

Insurance premium paid -  Matter was under consideration of the competent authority of the LIC, as to whether the proposal should be accepted or not -  The mere acceptance of a part amount does not amount to acceptance of the proposal. Held, The facts and circumstances of the case bring out that medical examination was conducted on the husband of the complainant at the time of submitting the proposal form.  According to the LIC, the medical reports were in the process of being evaluated by their Divisional Office, when the husband of the complainant died.  It is made out from these facts that there was no acceptance of the proposal in any form on the part of the LIC when the applicant died on 11.07.98.  The State Commission have also observed that the amount of Rs. 1,051/- in respect of each policy was received under the proposal “deposited receipts”, and not as a part of the premium for the proposal submitted.  The LIC have also stated that the first premium receipt-cum-acceptance letter had not been sent by them to the applicant.  We, therefore, have no reason to disagree with the conclusion of the State Commission that the mere acceptance of a certain amount from the applicant, does not amount to a concluded contract between the parties.   NCDRC ON LIFE INSURANCE 2017 ...28

Investigator report - Conclusion of the investigator is based upon something revealed during investigation - However, there is no evidence to show as to what is the source of that revelation - Therefore, it cannot be said that the petitioner has discharged its onus to prove that the insured had committed suicide - Thus, in our view, even the repudiation is not justified.   NCDRC ON LIFE INSURANCE 2017 ...168

IRDA (Policy Holders Interests) Regulations, 2002,  Regulation 8(3) – Insurance company should have been decided by the opposite party Nos. 1 and 2 within a period of 30 days and not more than 6 months i.e. latest by March, 2012 -   Thus, it was an utter disregard of the statutory provisions; the opposite party nos. 1 and 2 repudiated the claim on 19.3.2013, which took 2 years and three months to take decision in this matter - The basic issue involved in the present matter is whether the insured, suffered from any kidney disease etc. prior to submitting the proposal form for obtaining the policy and whether there has been any concealment of any material fact on his part - A perusal of the impugned order reveals that although the State Commission identified the crucial issue as stated above but they have not given any finding on the same, rather the State Commission passed their judgment based on the IRDA Regulations 2002 only, saying that the insurance company had indulged in deficiency in service in not deciding the claim within the time laid down in the Regulations -  It was the duty of the State Commission to have examined the entire evidence on record and then give a clear-cut finding on the question, whether there was any impersonation or fraud committed by the insured in any manner.    NCDRC ON LIFE INSURANCE 2017 ...73

IRDA (Treatment Of Discontinued Link Insurance Policies) Regulations 2010 - Whether the surrender value of the policy could be given to the complainant on the basis of the IRDA circular dated 21.12.2005, or the new circular issued in the year 2010 - IRDA (treatment of discontinued link insurance policies) Regulations 2010 were notified on 01.07.2010, whereas the policy was discontinued in the year 2011 and hence, the cause of action occurred to the complainant in March, 2011, which was much after the said regulations came into force -   The State Commission also observed that theConsumer Protection Act, 1986 is a beneficial legislation enacted with a view to protect the interests of the consumer.  Hence, wherever two interpretations are possible, the interpretation beneficial to the consumer, should be adopted.  A harmonious construction of regulations 1(2) and 2(1)(iv) of 2010 regulations would show that these are applicable in the case of policies, discontinued after coming into force of such regulations -  I have no reason to disagree with the findings given by the State Commission that the regulations of 2010 are applicable in the present case and hence, the surrender value is to be determined as per the terms and conditions in the 2010 regulations.    NCDRC ON LIFE INSURANCE 2017 ...61

Material concealment - Fact about his intake of alcohol in the proposal form  - Medical documents after his death, he was reported to be a chronic alcoholic with hypertension, ALD, Cirrhosis etc., but there is no material to establish that any of these conditions were occurring at the time of issuance of the policy - It has also been stated in the said documents that the deceased was suffering from hypertension for the last one year -  However, any basis for mentioning this period of one year, has not been indicated - A perusal of the proposal form indicates that the insured disclosed in the same that he used to take 100 ml of alcohol per week for the last 15 years - It has not been clarified anywhere if such an intake shall qualify him to be called a ‘chronic alcoholic’-  In any case, the deceased disclosed the fact about his intake of alcohol in the proposal form and hence, it was upon the Insurance Company to decide whether to issue the policy to him or not -  The insured could not be accused of providing any misinformation.   NCDRC ON LIFE INSURANCE 2017 ...148

Material concealment – In the Proposal form the deceased insured inter-alia maintained that he had not been admitted to any hospital or Nursing home for general observation, treatment or operation -   He had also denied having taken alcoholic drinks -   Statement of wife of the deceased insured wherein she inter-alia stated that her husband was a habitual drinker even before her marriage - Statement recorded on 19.9.2005 would show that the marriage happened about five years ago, meaning thereby it happened sometime in the year 2010 -  Therefore, the deceased insured obviously made a false statement in the proposal form when he denied consuming liquor.  Held, 7.      On merits, the learned counsel for the petitioner Corporation  has drawn my attention to the proposal form dated 16.12.2004, wherein the deceased insured inter-alia maintained that he had not been admitted to any hospital or Nursing home for general observation, treatment or operation.  He had also denied having taken alcoholic drinks.  He has drawn my attention to the statement of Smt. A.R. Sudha, wife of the deceased insured wherein she inter-alia stated that her husband was a habitual drinker even before her marriage.  The statement recorded on 19.9.2005 would show that the marriage happened about five years ago, meaning thereby it happened sometime in the year 2010.  Therefore, the deceased insured obviously made a false statement in the proposal form when he denied consuming liquor. 9.      The learned counsel for the petitioner has also drawn my attention to additional affidavit filed by the petitioner Corporation.  In the said affidavit, it is stated that as per the new business underwriting guidelines which were being followed during the relevant period, in the case of an occasionalConsumer consuming alcohol, the would have obtained physicians report, besides investigations such as SGOT, SGPT and GGTP.  All the aforesaid investigations pertain to the state of health of the liver.  Had the petitioner disclosed in the proposal form that he had been taking liquor he would have been subjected to physical examination by a physician and would also have been investigated for ascertaining the state of his liver by undergoing investigations such as SGOT, SGTP and GGTP.   It is therefore evident that the deceased had made a material concealment from the petitioner Corporation with respect to the state of his health which influenced advantage of the insurer on the question as to whether the proposal for insurance should be accepted or not.  On this ground also, the repudiation of the claim was fully justified.   NCDRC ON LIFE INSURANCE 2017 ...45

Material concealment – In the Proposal form the deceased insured inter-alia maintained that he had not been admitted to any hospital or Nursing home for general observation, treatment or operation -  The record from National Institute of Mental Health and Neuro Sciences Bangalore would show that the deceased had sustained injury of LS spine and had taken treatment for the said injury in the aforesaid hospital -   Therefore, it is obvious that a false answer was given by him in the proposal form when he denied having been admitted to any hospital for treatment or operation – Claim rightly repudiated. Held,      The learned counsel for the petitioner has also drawn my attention to additional affidavit filed by the petitioner Corporation.  In the said affidavit, it is stated that as per the new business underwriting guidelines which were being followed during the relevant period, in the case of an occasionalConsumer consuming alcohol, the would have obtained physicians report, besides investigations such as SGOT, SGPT and GGTP.  All the aforesaid investigations pertain to the state of health of the liver.  Had the petitioner disclosed in the proposal form that he had been taking liquor he would have been subjected to physical examination by a physician and would also have been investigated for ascertaining the state of his liver by undergoing investigations such as SGOT, SGTP and GGTP.   It is therefore evident that the deceased had made a material concealment from the petitioner Corporation with respect to the state of his health which influenced advantage of the insurer on the question as to whether the proposal for insurance should be accepted or not.  On this ground also, the repudiation of the claim was fully justified.   NCDRC ON LIFE INSURANCE 2017 ...45

Material fact  - An information which would influence the decision of the insurer as to whether it should accept the proposal or not and whether it should grant the insurance policy or not, would be a material fact, which a person seeking to obtain an insurance policy must necessarily disclose to the insurer that he had undergone a surgery in April 2005 -   Had he disclosed the said information, the insurer might or might not have accepted the proposal submitted by him -  The insurer might also have asked him to undergo additional investigations in order to verify the state of his health and the risk to his life on account of the surgery he had undergone in April 2005 -  It could also have asked for a higher premium, on account of the insured having undergone the aforesaid surgery -  Since the insured withheld the aforesaid material fact from the insurer while applying for the insurance policy, the insurer was fully justified in rejecting the claim on account of the aforesaid concealment.   NCDRC ON LIFE INSURANCE 2017 ...196

Material fact -  Concealment  - The contention taken by the complainant that the proposal form was filled by an agent, does not provide him any benefit, because it has not been denied that the said form was submitted by the life assured under his own signatures.   NCDRC ON LIFE INSURANCE 2017 ...190

Material fact -  Pension  -  Proposal form submitted by the father of the complainant, Mahabir Singh before the OP Insurance Company shows that he had mentioned in the column, ‘nature of duties’ that he was a pensioner and his source of income was pension and that he was getting Rs. 65,000/- per annum as pension -   On the other hand, it is amply made clear that Mahabir Singh was retired from the Haryana Roadways in the year 2008, because of his weak eyesight and that he was not drawing any pension -   Complainant had nowhere contradicted the version given by the OP Insurance Company that the life assured was not a pensioner -  It is evident, therefore, that it was the duty of the life assured to provide truthful and correct information to the Insurance Company at the time of filling up the proposal form -  The contention taken by the complainant that the form was filled by an agent, does not provide him any benefit, because it has not been denied that the said form was submitted by the life assured under his own signatures.   NCDRC ON LIFE INSURANCE 2017 ...190

Material fact concealment  -  Not proved  - Proposal form filled by the complainant on 28th March, 2012 wherein the complainant in response to the questionnaire pertaining to his health, particularly regarding heath ailment and diabetes mellitus has answered in the negative - Hospital record of 11.4.2013 wherein the concerned doctor has recorded that the complainant visited his clinic with history of pain in chest and uneasiness and that the patient was advised ECG which showed some changes - There is also a mention about diabetes mellitus-2 -  This document, is of no avail to the insurance company because the document is of the date after the submission of the proposal form -  Counsel for the petitioner has failed to show any evidence which could lead us to the conclusion that prior to 28.3.2012 the complainant was found suffering from any heart ailment or diabetes mellitus.    NCDRC ON LIFE INSURANCE 2017 ...56

Medical Certificates issued by Doctors - Dr. Rajendra Kumar is B.A.M.S.  and certificate neither bears any reference number nor date.  It is just hand written certificate -  There is no treatment details or any investigation by which Dr. Rajendra Kumar arrived at the diagnosis of chronic liver disease of the patient (insured) -   Similarly, the medical certificate issued by Dr. Paramjeet Singh Dhaliwal under his seal appears to be written on the plain paper -  In our view, it appears that the LIC and the doctors who have issued such certificates are working in cahoots with each other - It is clear that for the want of repudiation, the OP took medical certificates from two doctors, who were not qualified in allopathic medicine, who mentioned the diagnosis of chronic liver disease without any confirmation from laboratory investigations or ultrasound sheets -  Both the certificates/reports did not carry any importance as a medical certificate -  The PGI also have not given definitive diagnosis of alcohol liver cirrhosis - There is no conclusive evidence to show that DLA was suffering from chronic liver disease due to long alcoholic consumption.  Thus, the repudiation done by OP is unjustified  - Evidence.   NCDRC ON LIFE INSURANCE 2017 ...200

Medical record -  Record of Hospital – Insurance company could not produce the same since the said record was not traceable as informed by the hospital  - Even in his affidavit by way of evidence, the complainant did not claim that the breast cancer was detected after the deceased had obtained the revival of her insurance policy on 29.1.1993 -   He rather chose to altogether deny the treatment of the deceased at Tata Memorial Hospital -  No record of the treatment of the deceased at Tata Memorial Hospital has been produced to prove that her treatment in the aforesaid hospital was undertaken after 29.1.1993 -   Perusal of the letter dated 02.6.1997 sent by the complainant to the insurer would show that the treatment of the deceased in August, 1992 was expressly admitted by him in the aforesaid letter- No record from the Tata Memorial Hospital or elsewhere has been produced by the complainant to prove that the deceased has fully recovered after her surgery at Tata Memorial Hospital in Mumbai. -  No discharge summary has been filed by him though such a summary is provided by every hospital to every patient undergoing surgery as an Indoor Patient - Hold that the deceased was still suffering from cancer at the time she obtained renewal of the insurance policy on 29.1.1993.   NCDRC ON LIFE INSURANCE 2017 ...80

Medical record - Bed head tickets and doctor’s notes referred - Examination sheet of the Heart Hospital revealed that S was admitted in that Hospital on 16-12-2010 with complaint of chest pain since 7:00 A.M. and at one end, it was written as “DM/10 yrs”  - Under the caption “past history” it was written as “DM……yrs” , thus it itself indicates controversy - Eexamination sheet revealed the “advice” given by the doctor on admission of the insured and we do not find any medication given for diabetes mellitus except it was ordered that “to start NTG drip” and patient was under observation. She died at 6:50 P.M. by cardiac arrest -Letter issued by the Administrative Officer of Hospital states that “ according to our hospital records, Late Mrs. Shail Devi was suffering from Diabetes Mellitus for the last 10 years, as reported by the patient herself at the time of admission.” - Such letters can be created at any time - Vital record like bed head tickets and doctor’s notes in the medical record does not reveal anything about diabetes mellitus - Nothing on record to show that the patient was diabetic - No laboratory tests are produced to prove that she was diabetic - Also nothing was on record about the administration of any diabetic drugs during hospitalisation - Thus, the letter issued by Administrative Officer is a vague and unreliable which appears to be a procured one for the benefit of insurance company.   NCDRC ON LIFE INSURANCE 2017 ...90

Non-disclosure of the other insurance policies - Does not fall within the ambit of Section 45 of the Insurance Act, as the concealment was neither wilful nor fraudulent – On facts the Agent himself admitted that it is the normal practice that in non medi-claim policies, the question regarding   existence of other insurance policies is not asked and that he himself had filled the proposal form - By no stretch of imagination it can be held to be a material fact fraudulently suppressed, entitling the Insurance Company to repudiate the claim on the stated ground – Material fact.   NCDRC ON LIFE INSURANCE 2017 ...155

Policy – non delivery  - Premium paid  - Perusal of duplicate copy of the policy schedule, we find that it clearly records that date of payment of final instalment of insurance policy is 16.06.2012 -  Case of the petitioner is that he could not avail 15 days free look period because the insurance policy was never transmitted to him -  The above plea of the petitioner is unimaginable -  Had the petitioner not received the insurance policy, it is unimaginable that he would  have continued to pay the annual premium of Rs.5,00,000/- each for next three years without approaching the opposite party insurance company for delivery of insurance policy.    NCDRC ON LIFE INSURANCE 2017 ...184

Policy – Pre dated – Suicide  - Proposal form submitted for obtaining the insurance policy was 25.11.2009 on which date policy was issued -  Although the date of commencement of risk has been pre-dated 28.9.1999 the date of issue of policy is 25.11.1999 -  Life assured committed suicide on 9th October, 2002 i.e. within three years from the date of issue of policy - Condition 4 (B) excludes the liability of the insurance company to pay insurance claim for the death of the life assured due to suicide committed within three years of the date of issue of policy, the insurance company was justified in repudiating the insurance claim.   NCDRC ON LIFE INSURANCE 2017 ...85

Policy – Terms and conditions not alleged to be supplied  - Complainant stated that they were only given two pages of the policy and the terms and conditions of the policy were not made available to them and the petitioner was unaware of the same - In the two pages of the policy allegedly given to the petitioner, it has been clearly mentioned -“We urge you to go through the conditions and privileges under the policy and familiarize yourself with various benefits and conditions available to you and other members covered”- Petitioner could not explain the reasons why the petitioner did not ask for the full documents of the terms and conditions of the policy, if he had not received the same, even after receiving the two pages wherein it had clearly been requested to go through the same by the insurance company - The State Commission has correctly relied on the terms.    NCDRC ON LIFE INSURANCE 2017 ...135

Proposal – Signature  - Proposal form submitted for purchase of insurance policy under ‘Life Long’ plan and it bears the signature of the petitioner -  It is not the case of the petitioner that proposal form was filled in by someone else -   Thus, it is clear that petitioner has submitted proposal form with clear knowledge and intention to purchase insurance policy under “Life Long Plan”.    NCDRC ON LIFE INSURANCE 2017 ...184

Proposal not accepted -  Policy not issued  -  Insurance cover could not have commenced without the application form having been accepted by the petitioner company and the said acceptance having been communicated to him - There is absolutely no evidence of the proposal submitted by the deceased having been accepted at any point of time - Therefore, the insurance cover never commenced in this case - That precisely seems to be the reason why no policy document was ever issued by the petitioner to the complainant.   NCDRC ON LIFE INSURANCE 2017 ...52

Revival of policy  - False  declaration while obtaining revival of the insurance policy - The policy was obtained on 08.11.1991, whereas its revival was obtained on 29.1.1993 - Deceased was operated at Tata Memorial Hospital in or around August, 1992, the declaration submitted by her while seeking revival of the insurance policy on29.1.1993 was patently false since she did not disclose at that time that she had been operated for breast cancer at Tata Memorial Hospital and she claimed to be in a good state of health.    NCDRC ON LIFE INSURANCE 2017 ...80

Suppression of material facts  -  Complaint has not denied the finding of the Respondent that insured was suffering from Thalassemia since childhood - Merely contended that death of the deceased was not due to Thalassemia -  It has been correctly observed by the State Commission in their impugned order that non-disclosure of material facts by the deceased-insured, regarding his health at the time filling up the proposal form  renders the ‘Insurance Contract void’ . Held,    NCDRC ON LIFE INSURANCE 2017 ...  NCDRC ON LIFE INSURANCE 2017 ...  NCDRC ON LIFE INSURANCE 2017 ....undisputedly the deceased—insured had suppressed the material facts regarding his health from the Respondent and did not mention these facts  in the proposal form while taking the insurance policy that he had been suffering from Thalassemia since childhood and had been taking treatment for that disease prior to the insurance policy.  Hence, I have no hesitation in holding that the deceased—insured, Sh. Sachin Chhabra, had suppressed the material facts from the Respondent while taking the insurance policy in question.   NCDRC ON LIFE INSURANCE 2017 ...37

Vernacular – Sign in Telegu  - It is transpired that the proposal form was filled in English by the agent of insurance company and the signature of proposed insured was in vernacular language i.e. Telugu.  On its face, it appears that the insured is illiterate and he was unable to put his signature properly.  There is no medical record to prove that the OP was suffering from Asthma.  The cause of death was not known.  He died during the sleep.  There is no evidence that the death was due to Asthma, which was mentioned in the repudiation letter.   NCDRC ON LIFE INSURANCE 2017 ...131